Method and system for performing endoscopic surgery at locations where tissue inserts into bone

Abstract

An endoscopic system and method for performing endoscopic surgery at locations where tissue inserts into bone which includes a sleeve member, obturator, cutting and excision instruments, and a marking and insertion assembly wherein the sleeve member has an expanded portal through which instrument access and improved visualization can be performed at arcuate lines of insertion of tissue into bone. The sleeve member can include a flange for engaging tissue along the line of insertion and exposing the bone and measurement means for gauging precisely the reduction or resection of bone. An alternative embodiment of the sleeve member has a non-uniform aperture with an instrument portion and a register portion providing increased space and maneuverability for instruments when operating at the portal on tissue or bone that can include the flange. Cutting instruments are provided with an extension portion to extravasate from tissue and palpitate underlying tissue. An marking and insertion assembly for use in heel surgeries to remedy plantar fasciitis and in conjunction with a lateral radiograph provides precise location of an entry incision and precise medial to lateral insertion of a guide wire forming a channel for the sleeve member. The method system also provides for minimum incision surgery in the caudal release of the plantar fascia and reduction of a spur on the os calcis.

What is claimed and desired to be secured by Letters Patent of the United States is: 
     
       1. A device for use in performing endoscopic surgery at the interface of tissue and bone, comprising: a tubular sleeve member having open ends and defining a portal opening along the length of said sleeve, and a   slot extending longitudinally along said sleeve, said portal opening interconnected to said slot intermediate said open ends, said portal opening being circumferentially wider than said slot for forming an expanded surgical site with simultaneous access and visualization of the interface of tissue and bone.   
     
     
       2. The device of claim 1 wherein said portal opening is defined between two side edges, said device further including flange means integrally attached to one of said side edges and extending outward from said sleeve for exposing a bone generally adjacent said sleeve by engaging and moving the tissue away from the bone. 
     
     
       3. The device of claim 2 further including measuring means for gauging the reduction of the bone to a predetermined dimension, said measuring means being formed by said flange means. 
     
     
       4. The device of claim 1, further including an obturator having a shaft configured to pass into said sleeve member, a tip at one end of said shaft and a stop means at the other end for contactingly engaging said sleeve member to position said obturator so that said tip extends outward from said sleeve when said obturator is inserted into said sleeve. 
     
     
       5. The device of claim 4, wherein said tip forms a blunt bullet shape for separating overlapping tissue. 
     
     
       6. The device of claim 4, wherein said tip form an elongated bill shape for separating overlapping tissues. 
     
     
       7. A surgical device for use in performing endoscopic surgery within a human body comprising: a tubular sleeve adapted to penetrate the human body and having opposite open ends, said sleeve defining an interior passageway extending the length of said sleeve, one of said open ends being adapted for the introduction of an endoscope into said passageway and the other end being adapted for the introduction of surgical instruments into said passageway, said sleeve having a slot formed along its longitudinal length to intersect said interior passageway, and a portal opening formed intermediate the length of said slot and having greater circumferential width than said slot for enabling greater access to the adjacent human body for manipulation of said endoscope and surgical instruments.   
     
     
       8. The device of claim 7 wherein said portal opening is defined between two longitudinally extending side edges. 
     
     
       9. The device of claim 7 wherein said portal opening is disposed approximately midpoint along the length of said sleeve. 
     
     
       10. The device of claim 7 further including grip means attached to said sleeve for manipulation and orientation of said sleeve. 
     
     
       11. The device of claim 10 wherein said grip means is disposed about and attached to one of said open ends, said grip means including a generally disk shaped collar defining gripping indentations about the circumferential surface of said collar. 
     
     
       12. The device of claim 7 further including an obturator having a shaft with a distal end and a proximal end, said passageway of said sleeve being configured for slidable insertion and removal of said shaft. 
     
     
       13. The device of claim 12 wherein said obturator defines a central bore extending the length of said obturator, said central bore sized for the passage of a guide wire. 
     
     
       14. The device of claim 7 wherein said passageway is formed with a generally circular transverse cross section. 
     
     
       15. The device of claim 7 wherein said sleeve includes a lower arcuate surface opposite said slot and portal opening, said passageway having a non-circular cross section, said sleeve defining an upper instrument portion of said passageway having a generally circular transverse cross-section and a lower register portion interconnected to said instrument portion and defined by said arcuate surface. 
     
     
       16. The device of claim 7 wherein said portal opening is defined by at least one longitudinally extending side edge, said sleeve also including an outward extending flange connected to said side edge. 
     
     
       17. The device of claim 16 wherein a measuring scale is formed on said flange. 
     
     
       18. The device of claim 7 wherein said slot longitudinally extends from one of said opposite ends to the other of said opposite ends. 
     
     
       19. A surgical device for use in performing endoscopic surgery within a human body comprising: a tubular sleeve adapted to penetrate the human body and having opposite open ends, said sleeve defining an interior passageway extending the length of said sleeve, one of said open ends being adapted for the introduction of an endoscope into said passageway and the other end being adapted for the introduction of surgical instruments into said passageway, said sleeve having a slot formed along its longitudinal length to intersect said interior passageway, and a portal opening formed intermediate the length of said slot and having greater circumferential width than said slot for enabling greater access to the adjacent human body for manipulation of said endoscope and surgical instruments; and   an obturator having a shaft with a distal end and a proximal end, said passageway of said sleeve being configured for slidable insertion and removal of said shaft.